Time is of the essence

19 August 2017:

Antonio Dans, clinical epidemiologist, cardiologist and professor at the UP College of Medicine, has been researching on tobacco since 1993, when he decided to focus his research on preventive rather than curative medicine. Why tobacco? Because even then it was the biggest risk factor for health—beating hypertension, diabetes, and high cholesterol. And the stakes are getting higher.

Dr. Dans guested in “Bawal ang Pasaway,” the TV show I host, and the episode will be shown on Monday evening. He was one of the stalwarts behind the passage of the Sin Tax Law (Republic Act No. 10351) in 2012, and is very active in the move to include a reformed Sin Tax bill in the TRAIN (Tax Reform for Acceleration and Inclusion). But definitely not House Bill 4144, which was passed recently, and which antismoking advocates call, only half-jokingly, “HB Poor Juan Poor Poor.” And he joins over 60 medical organizations in the Philippines as well as other civil society groups which have gotten together to petition President Duterte to make sure that TRAIN includes sin taxes.

Now why am I jumping the gun, so to speak, and writing about the interview before it is aired? Because I got infected with Dr. Dans’ “time is of the essence” pitch, and you will, too, once you know all the issues.

Why is time of the essence? Let us count the ways:

1. There is compelling evidence that highlights a close association between smoking and drug abuse. One US study shows that a smoker is three times more likely to be an illicit drug user than a nonsmoker.

The same study shows that a smoker’s quit rate was less than half that of a nonsmoker.

Another study concludes that smoking may be a “gateway” to drug use: Those that had smoked cigarettes were 13.9 times more likely to use crack (closest to shabu) than nonsmokers, 7.5 times more likely to use cocaine, and 7.3 times more likely to use marijuana.

And a third study shows that smokers are 4.86 times more likely to relapse than nonsmokers, if they ever quit.

LESSON: If we want to succeed in the war on drugs, we better start with prevention. Less smokers, less illicit drug users.

2. Every day that a new sin tax bill isn’t passed means around 550 new smokers—which means 1 million new smokers by 2022. Why? Because although the 2012 Sin Tax Law was highly successful—3.8 million less smokers in 2017 than in 2012, and dramatic improvements in healthcare financing and delivery because of the revenues from the sin taxes (P331 billion from tobacco alone)—the fact is that time, or rather population and income growth, have softened the punitive aspects of RA 10351. And Dr. Dans and his colleagues say that without a new sin tax law, smokers will increase by 1 million in 2022.

Reader, in case you got lost, let me summarize. Smoking is a gateway to drug use: A smoker is up to 14 times more likely to get into drugs. Once in, his quit rate is less than one-half of his nonsmoking counterpart. Having quit, he is five times more likely to get back into drugs.

So, if the war on drugs is to be won, let’s try to prevent as much smoking as possible. Time is of the essence.

But RA 10351 is going to end up adding 1 million smokers by 2022. So it must be amended.

What kind of tax increases will stop that? A tax increase of 60 percent, for 2018, plus 9 percent a year after that (according to Jo-Ann Latuja Diosano). “HB Poor Juan Poor Poor” envisages an effective tax increase of 10 percent, with increases of about 4 percent after that. It also wants two tiers of taxes—6 percent for the low-cost cigarettes, and 20 percent for the high priced. In effect, they think that the poor are not worth saving.

Is 60 percent too much? Of course not. As of 2016, the retail prices of Philippine cigarettes were the lowest in ALL of Asia. Only Cambodia, Kyrgyzstan, and TimorLeste had the same low prices.

That I have focused on smoking and its relationship to drug abuse doesn’t mean that smoking has no other effects—the number of diseases (49) in which it is a major cause and the direct and indirect costs of fighting those diseases (P210 billion annually for only the major four diseases).